Are we Providing Timely Access to Musculoskeletal Outpatient Therapy Services? An Exploratory Study

Access to NHS and social care services has been of increasing public interest for many years. Increasing waits to services has been long documented, and the COVID-19 pandemic saw waiting times soar to an all time high. This is not favourable because of the known negative impacts experienced by the waiter, when waiting longer for the services they need. Improving access to services is not only a National Driver featured throughout policy (A Healthier Wales, 2018) but a legal obligation (Duty of Quality, 2023).

Access to services in Wales has been studied by Welsh Government for decades. This is usually measured by the time taken in weeks from referral to treatment, and is supported to be necessary in some areas, whereby increased waiting time can result in morbidity, or mortality, for example, heart attacks and strokes. Literature exploring impact with wait is lacking when considering many areas of health, for example musculoskeletal conditions. However, such services are also duty bound to report their waiting times to Welsh Government.

Outpatient MSk Therapy Services, for example, report how long each person waits before an initial appointment is offered, in number of weeks. An appointment offered within 14 weeks of referral is considered 'timely' and people waiting over this time are considered to be 'breaching'. How this target became to be considered significant is not publicly justified. The impact of those waiting over 14 weeks on the person waiting, is not known.

Impact exploring those waiting for treatment for musuculoskeletal disorders is extremely limited. However, preliminary, retrospective study during COVID-19 suggests that those waiting for these services during this time, experienced a diversity of impact, from symptom recovery to deterioration of condition. The variables observed differed between individuals, as opposing to differing lengths of wait, and seemed to be influenced by personal factors such as socioeconomic and mental health status. This provides an insight that impact of wait is variable between individuals and does not align with current study of accessibility subjecting all people to the same arbitrary target without knowing what happens around this time. Investigators know that future health and social care services need to be sustainable for the NHS to survive. Investigators know that they need to look at things differently, considering the quality of the care that is provided rather than the quantity, and they are duty bound to explore how the NHS is doing with respect to quality, using both qualitative and quantitative information, involving all stakeholders. They know that this is vital to inform positive system change. However, there is no current exploration into the experience of waiting for MSk services, in the eyes of the waiter, as they wait. Understanding this may help investigators to understand what a future model of MSk Outpatient healthcare should look like with respect to accessibility, and implement a sustainable solution for future generations. This is assuming that their current understanding of wait is inadequate, or not appropriate, based on the information available communicating accessibility through use of an arbitrary, unjustified blanket target for all, which remains an unknown.

This research project aims to understand the impact of chronological wait for people waiting for Musculoskeletal Therapy Outpatient Services, with reference given to under and over 14 weeks, to understand if the current target is effective at communicating how services are doing in this domain. It will also explore the lived experience of waiting in the eyes of the waiter, and seeks to understand whether this understanding aligns with what is seen when studying impact of wait chronologically, with a view to provide a quality rich understanding of the impact of waiting for these services, and provide a direction of travel for future study.